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Cognitive therapy best for social anxiety disorder

Social anxiety disorder is one of a spectrum of depression and anxiety disorders. One can find that many symptoms can overlap such as guilt, worrying, nervousness, insomnia, fatigue and loss of interest. Among this spectrum, social anxiety disorder is the second most common impacting some 13%.

Questionnaires for social phobia will often lead to answers that speak to fear of embarrassment causes one to avoid doing thins, avoidance of activities where one is the centre of attention, being embarrassed or looking stupid are worse fears, fear of people in authority, fear of criticism etcetera. In social anxiety disorder or social phobia, there is marked or persistent fear of social or performance situations. Exposure or anticipation of a social or performance situation provokes anxiety and leads to avoidance. These people simply cannot function and suffer significant distress in both social and occupational functioning.

Tasks such as public speaking, writing, eating or playing sports in front of others are difficult to do. Even tasks such as entering a room full of people or using a public washroom can be a challenge. Interactional events such as making small talk, asking a teacher for help, speaking to a boss or asking a sales clerk for help are difficult. Dating, lunching with peers or going to a party can be an impossible task.

Further, this is an under diagnosed disorder with only 5% of patients with the issue ever seeking help. In a primary care of 2000 patients where 5% met criteria for diagnosis – only 25% were diagnosed. The mean age of onset is 14- 16 years and if these youth remain undiagnosed, it has significant long term impact on both their personal and professional life.

We do know there is a genetic role as if an identical twin is social phobia, 25% of identical twins will both have it and 15.3% of fraternal twins Parents with social anxiety disorder are more likely to have children with the same diagnosis. It is also felt that other biological and interpersonal factors play a part in its cause and as such each have led to different treatments.

Treatment includes both medication and psychological support. In this week’s Archives of General Psychiatry is an original piece of research looking at treatments for Social Anxiety Disorder. The 2 treatments looked at were cognitive therapy and interpersonal psychotherapy.

Cognitive therapy focuses on changing and modifying the way information is understood. It changes the biases and dysfunctional beliefs that are present. On the other hand interpersonal psychotherapy tries to change interpersonal behavioural patterns that can impact in this disorder and modify and explore interpersonal relationships. Role playing can be used to enhance communication and social skills.

What was found was that both treatments were better than placebo. Between the two treatments, cognitive therapy led to the most improvements and these improvements persisted for 1 full year after treatment.

We know if left untreated SAD will take a long term course and put these people at significant handicaps for both careers and social relations. These two treatments results in significant improvements.